Appeals & Disputes

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Provider Appeal Process
This document provides an explanation of the provider appeal process for medical necessity, experimental, or investigational procedures/services.
(36 KB) Download PDF
English

Provider Billing Dispute Process
This document provides an explanation and forms for appealing an adverse decision, including when and how to submit a dispute.
(60 KB) Download PDF
English

Adverse Medical Necessity – External Review Determinations
This document includes number of Adverse Medical Necessity Determinations sent to external review for final determination for the proceeding calendar year and the percentage that are upheld or reversed.
(56 KB) - Download JPG

Compliance Dispute Process

Includes contact information and instructions for initiating a compliance dispute pertaining to the terms of the class action settlements.